Pancreas transplant in chronic kidney disease for type 1 diabetic patients
Rashikh Choudhury1, Dor Yoeli1, Hunter B. Moore1, Hillary Yaffe1, Trevor L. Nydam1, Peter Kennealey1.
1Department of Surgery-Division of Transplantation Surgery, University of Colorado Hospital, Aurora, CO, United States
Background: Although both pancreas transplantation alone (PTA) and islet cell transplantation (ICT) have been associated with peri-operative declines in eGFR, the magnitude of decline is far less than that associated with medically managed (MM) diabetes. In the long-term, PTA and ICT have demonstrated stabilization of chronic kidney disease (CKD) for type 1 diabetic patients. In this setting, it remains unclear whether transplantation reduces future need for kidney transplantation and mortality.
Methods: A decision analytic Markov state transition model was created to simulate the life of type 1 diabetic patients with CKD who underwent one of three interventions: 1) PTA, 2) ICT, or 3) MM. Estimated declines in eGFR, chance of requiring kidney transplant, and mortality were estimated following each intervention for a simulated cohort of 3,000 patients. Base case patients were defined as 30 year old type 1 diabetic patients with an initial eGFR of 30 ml/min/1.732. Sensitivity analysis of initial eGFR was performed. Markov model parameters were extracted from literature review (1-4).
Results: PTA and ICT was associated with improved long-term survival across a spectrum of initial eGRF (15-60 ml/min/1.732). For base case patients, ICT patients required few transplants, and gained 17.8 years of life compared to MM patients, and 3.8 years of life compared to PTA patients.
Conclusion: ICT is associated with stabilization of eGFR, thereby reducing need to future kidney transplantation and improving long-term survival.
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